Studies show that for every $1 spent on workplace wellness, employers save $3 in health care costs. So why doesn't every company have its own workplace health promotion plan? Too expensive? Not effective? Difficult to implement? Not so! Read on to learn proven strategies for building a health program that works-at work.

Close your eyes and try to guess where you are: A place where you can enjoy a nutritious breakfast of low-fat yogurt, fresh fruit, and multi-grain cereal with skim milk; have easy access to the latest medical information, fitness tips, and healthy recipes; take a vigorous 30 minute walk with friends; get a stress-relieving massage; and enjoy the company of people equally committed to healthy living.

So where are you—at a posh South Beach spa that charges a well-toned arm and a leg? No, at this healthy destination, you get paid for attending—it's your workplace! And not the workplace of the distant future but the 21^st century workplace that the US Department of Health and Human Services (HHS) hopes both large and small businesses establish by 2010, as part of the Department's Healthy People 2010 prevention agenda.

This health initiative, formulated by Partnerships for a Healthy Workforce, an alliance of employers committed to improving employee and community health sponsored by the Department's Office of Disease Prevention and Health Promotion, is based on two unassailable facts: most adults typically spend more than half their waking hours at their worksites; and worksites have a powerful impact on individuals' health. Given these realities, Healthy People 2010 has articulated two major worksite-specific objectives:

• to encourage at least 75 percent of American employers, regardless of size, to offer a comprehensive employee health promotion program; and
  
  
• to have at least 75 percent employee participation in employer-sponsored health promotion activities.

Why has the federal government become involved in the seemingly personal matter of practicing good health habits? Aside from its Constitutional mandate to "promote the general welfare" of the American people, the Feds have recognized that the US, if it is to maintain its economic pre-eminence in an era of increasing global competition, must have a highly productive workforce—and both productivity and profits drop when workers suffer from chronic illnesses. In its 2003 policy statement "Prevention Makes Common ‘Cents'," HHS warns:

"Resources and energy need to be marshaled in all sectors and at all levels of society—…governments, foundations, associations, health care providers and insurers, businesses, communities, schools, families, and individuals—to control and prevent the chronic conditions that threaten the Nation's physical and financial well-being."


America's "Growing" Health Problem

Too often in the past, workplace health promotion (WHP) programs tended to be loosely organized initiatives that companies instituted for maybe a month, with poorly defined goals, limited employee participation, and no measurable criteria for evaluation. An employer might pay for smoking cessation programs for employees, test workers for drugs and alcohol (when permissible), and boast that the company had a "wellness program" in place.

No more. Businesses today must adapt to a new workplace paradigm, one in which employers are legitimate stakeholders in their employees' health. Thus, maintaining optimal health by eating right and exercising is not something only to be done outside the workplace, during one's "free" time, but rather a seamless part of an individual's everyday schedule, work included. This model, HHS envisions, will result in healthier employees and healthier bottom lines for businesses, thanks to increases in productivity and morale and decreases in absenteeism and health costs.

Undoubtedly the most serious and prevalent health problems of American workers today are not those caused by smoking or drinking; they are the chronic conditions resulting from obesity, including diabetes and cardiovascular disease. The Centers for Disease Control and Prevention has stated recently that 30 percent of all adults in the United States are obese, a doubling of the rate since 1980, and has noted that "the situation is worsening rather than improving." The National Business Group on Health now considers obesity a greater trigger for health problems and increased health spending than either smoking or drinking. The group's 2002 report published in the Journal of Health Affairs states that "individuals who are obese have 30 to 50 percent more chronic medical problems" than heavy smokers or drinkers. Mark V. Pauly, professor of health care systems, business, and public policy at the University of Pennsylvania's Wharton School, affirms that "obesity is a strong predictor of medical expenses." And both employers and employees have struggled to meet the steadily rising costs of health care.

Can both small and large employers afford to initiate a WHP program? The real question may be: can they afford not to? The Partnerships for a Healthy Workforce has stated unequivocally that "for about the cost of the holiday party, or the installation of new carpet, [even] small businesses can…support broader health promotion efforts that can pay big dividends to companies, employees, and the community-at-large."


Designing a WHP Program That "Works"

The good news is that obesity and its attendant health problems are considered "preventable" and that the trend can be reversed—hence the HHS's Healthy People 2010 agenda. And as more and more companies achieve success with their WHP programs and demonstrate a significant ROI (for more on this subject, see October's article "Health Equals Wealth"), a clearer picture is forming as to how both small and large companies can design and implement their own WHP program, suited to their employees' particular needs and goals as well as to their available resources.

Timothy McDonald, manager of corporate health programs for GM Health Services, frames the question like this: "We know the consequences of lifestyle-related problems. The question really is, ‘What is an effective intervention and how do we do it?'"

HHS's Office of Disease Prevention and Health Promotion, through the Partnerships for a Healthy Workforce, has responded by developing a ten-step process that "can be used by employers of all sizes to increase the success of any health promotion program." Though the steps are sequenced, businesses can modify and combine them to best suit their workplace.

1. Establish a planning committee. To ensure that potential participants "buy into" the program, the committee should include a cross-section of employees from all levels in the company. The committee should include individuals who have some responsibility for establishing employees' schedules and allocating funds, as well as individuals both enthusiastic and skeptical about the program. The planning committee is vital to the success of the WHP program for maximizing employee participation and for designing a program that is responsive to employees' actual needs and desires.



2. Assess employees' needs and interests. If the WHP program is to have any success, it has to take into account the needs, interests, and expectations of participants. To this end, a brief survey should be administered to employees to determine such data as which health promotion activities most interest them; the most convenient times and places to schedule activities; and suggestions for organizational changes to promote a healthy work environment.



3. Write a mission statement, goals, and objectives. The mission statement expresses the values underlying the program (i.e., "the importance of improving employees' health and well-being"); the goals establish specific, measurable, long-term accomplishments (i.e., "reducing absenteeism 20 percent in a year"); and short-term objectives that include action steps (i.e., "taking 20 minute lunchtime walks 3 times a week"). Follow the SMART model in establishing goals and objectives: make your goals Specific, Measurable, Action-based, Realistic, and Time-oriented.



4. Develop a timeline and budget. The timeline must be realistic and sufficient to implement the program. The budget should be adequate but not extravagant, as research has shown that programs with moderate costs are more likely to produce cost savings. Inform employees that the program may include cost- sharing on their part.



5. Select incentives. People need motivation to effect lifestyle changes. External rewards for achieving program goals can include cash bonuses, time off, increased insurance coverage, etc. Choose those incentives that will have the widest appeal to your workforce.



6. Take advantage of outside support mechanisms. Many hospitals host free health fairs and seminars in which your workforce can participate. Pharmaceutical companies, health care providers, and local health organizations often provide high-quality health information and disease management programs for free or at low cost. These support mechanisms can be a boon, especially to small employers, and can produce excellent results with little expense, if marketed properly to your workforce.



7. Market the program. The program will be "dead on arrival" if it is not sold to employees. Emails, posters, newsletters, and, best of all, positive word-of-mouth feedback from participants can be used to maximize participation. A creative name and logo for the WHP program can also be an effective advertising tool. Remember that even a good product will fail if its marketing campaign is deficient.



8. Implement the program. Hasn't some athletic shoe company enjoyed success by urging its customers to "just do it"? That's also good advice when initiating a WHP program. Planning is important but shouldn't hold up implementation of the program indefinitely. Lead off with those activities most likely to succeed—instituting a "Healthy Breakfast" club; organizing walking or stair-climbing breaks during the workday; or distributing tips for healthy living and recipes via newsletter or email, to name a few. Such small steps cost little and may inspire employees to commit more fully to making even greater lifestyle changes.



9. Evaluate the program. All successful WHP programs include an evaluation process that examines how the program is working (process measures) and whether or not it is achieving desired results (outcome measures). As David Hunnicut, president of the Wellness Councils of America (WELCOA), points out, "You can't change what you can't measure." If the program is not achieving the specific measurable goals established at its inception, then it has to be modified and improved.



10. Modify the program as needed. The truth is that getting adults to change their lifestyle and health habits isn't easy; neither is choosing the most appropriate and effective interventions for your workforce. But that's no reason not to start a WHP program and all the more reason to tweak it to increase its effectiveness. After a specified time (say three months), the planning committee can make needed changes after reviewing the results of its evaluation.

Establishing a WHP program that attracts widespread participation and that succeeds in improving the health of your workforce is not a "win or lose" proposition. While complete success may be unrealistic, Daniel Zank and Donna Friedsam of the Wisconsin Public Health and Health Policy Institute point out that a variety of studies have suggested that "even relatively modest levels of participation can achieve substantial program impact." There is "no silver bullet on the horizon" to reverse the trend of rising corporate health care expenses, says Randall Abbott, senior health care consultant at Watson Wyatt Worldwide. But the option of doing nothing to encourage employees to make healthier lifestyle choices is no longer an option; employees, companies, and the nation have too much at stake.

Much needs be done to improve Americans' health, and much can be done at the workplace. Former HHS Secretary Tommy Thompson has stated:

"So many of our health problems can be avoided through diet, exercise, and making sure that we take care of ourselves. By promoting healthy lifestyles, we can improve the quality of life for all Americans, and reduce health care costs dramatically."

Good advice you can take to the bank—and to the workplace.